The Essential Guide to Breastfeeding in Bristol 2012 designed by nature, made by mum NATIONAL BREASTFEEDING HELPLINE 0300 100 0212 Available 9:30am - 9:30pm everyday www.bristol.nhs.uk/your-health/breastfeeding.aspx
What s in this issue... 4 Bristol Breastfeeding Policy Bristol PCT Commitment to families 5 Making Milk What happens when 6 Breastfeeding Positions Different ways to position your baby 8. Good Attachment How do I know how my baby is attached properly? 9 Good Attachment A picture guide to attaching my baby properly 10 Hand Expressing Why s and how s of hand expressing 11 Physical Challenges Troubleshooting common problems 12. Baby s Nappies What is normal and when 13. Special Circumstances Breastfeeding a Preterm or Ill Baby 14. Introducing other food First Foods and Weaning 15 Returning to Work Advice for when you go back to work 16. The Directory Your Pathway to Support in Bristol 17. Milk Banking & Breastfeeding Helplines Telephone numbers for helplines 18. Bristol Breastfeeding Peer Support Service What it is and how you can access it 19. Support Groups in Bristol Breastfeeding Support Groups 20. Support Groups in South Gloucestershire Breastfeeding Support Groups 21. Breastfeeding Friendly Places in Bristol Welcoming Public Places across Bristol 22. Breastfeeding Friendly Places in Bristol Welcoming Public Places across Bristol 23. Support & Information: National and Local Helplines and Websites The Real Baby Milk project wouldn t be possible without the support and help from so many people and organisations Real Baby Milk was started by Cornish mum of three, Arwen Folkes, in 2005 after having a challenging time breastfeeding her first baby but succeeding due to the right information and support being available to her. The Essential Guide is designed to enable women to have easy access to the correct information and support that is available to them, giving them the best chance of succeeding too. Real Baby Milk is not for profit and run by mums, for mums. Many people and organisations have supported the project over the years and we are grateful to them all but in particular: Helen Shanahan, Stephanie Heard, Mary O Connell, Cornwall Council Family Services, Royal Cornwall Hospitals Trust and the volunteer mums across Cornwall all ready to support you and your baby. Health professionals please re-order this guide from the health promotion service tel 0117 3235463 Keep in touch with Real Baby Milk realbabymilk.org/newsletter facebook.com/realbabymilk twitter.com/realbabymilk 2 realbabymilk.org
Skin to skin Keeps baby warm Calms baby s heartbeat Reduces mum s and baby s stress levels Regulates baby s breathing Helps with baby s first feed Why breastfeed? Breastmilk is your way of providing your baby with all the nutrients he/she needs. Breastfeeding not only benefits your baby but you too. The World Health Organisation recommends exclusive breastfeeding for about the first 6 months and continued breastfeeding alongside other foods beyond your baby s first birthday. This will give your baby the best start in life. However, any amount of your breastmilk will always be good for your baby s health and wellbeing Helps protect you against P Breast cancer P Ovarian cancer P Osteoporosis (weak bones later in life) P Obesity (helps you lose weight) P Diabetes Helps protect your baby against P Severe diarrhoea and vomiting P Chest infections P Asthma P Eczema P Ear infections P Obesity P Diabetes Getting off to a good start... Early skin to skin contact with baby This is important for all babies for their health and well-being and tells your body it s time to make milk! Early feed Baby receives vital colostrum, nature s first vaccine and your milk supply is kick started. Baby led feeding Let your baby lead the feeding, feed them whenever they ask. Frequent feeding will tell your body when and how much milk is needed Make sure your baby is well-attached Ask a midwife or visit a support group for help. Learn how milk is made - understand what your body is doing! realbabymilk.org 3
Bristol Policy on Breastfeeding All staff working with mothers and babies have regular training to support them in this role. How we will help mothers to breastfeed successfully NHS Bristol has a Breastfeeding Policy based on the UNICEF UK Baby Friendly Initiative best practice standards which guides staff in their practice. All pregnant women have the opportunity to discuss breastfeeding with a health care professional. Women can learn about the benefits of breastfeeding, ways that they can help breastfeeding to get off to a good start and how to continue for as long as they wish. All mothers are encouraged to hold their baby in skin contact after birth, ideally at least until the baby has had a first breastfeed. Skin contact is a lovely way of getting breastfeeding off to a good start and can help to resolve difficulties and settle babies at any age. Breastfeeding mothers are helped to learn the skills of positioning and attaching their baby for successful breastfeeding. This support is provided by midwives, health visitors and their teams. All breastfeeding mothers are supported to learn the skill of hand expressing. This is helpful for expressing milk and avoiding/managing breastfeeding challenges. Mothers are encouraged to keep their baby near them, so that they can respond to their feeding cues. They are encouraged to feed their baby whenever s/he wants, for as long as s/he wants. This baby-led feeding ensures a good milk supply and a contented baby. Mothers are given information about the possible problems which using teats and dummies can cause for breastfeeding and can then make an informed choice about these issues. Mothers are encouraged to breastfeed their baby for 6 months and then introduce solids alongside breastfeeds after this. If formula milk supplements are recommended by staff, this is only for a medical reason and the mother will have full information about why this is being suggested. All health service premises welcome breastfeeding mothers and babies. Mothers are given information about other local places that welcome breastfeeding mothers. Mothers are given help to keep breastfeeding when they return to work. Breastfeeding mothers are given contact details of local breastfeeding support groups, local voluntary groups and national help lines. If you have any questions about this policy, please contact: Nicki Symes on 0117 9002236 To view the full policy please go to the NHS Bristol website on www.bristol.nhs.uk/your-health/ breastfeeding/breastfeeding-in-bristol.aspx 4 realbabymilk.org
Making Milk What happens when? At Birth Mum s breasts produce very special milk colostrum. This is thick and concentrated and may be clear, white, yellow, green or red in colour! These colours are normal and colostrum contains precious antibodies to protect baby from infections. Colostrum has a strong laxative effect which the baby needs to clear its gut of sticky meconium poo. Colostrum comes in very small amounts as the newborn baby has a stomach the size of a marble and is meant to take frequent small feeds. The amount he takes gradually increases over the first few days. Day 3 / 4 Mum s milk starts to come in, her breasts often feel heavy and there is also a hormone surge at this stage which can make mum feels very bluesy. Mums can often feel highly emotional and may associate this with breastfeeding. This is all normal and begins to settle down within 24-48 hours. If mum continues to feed the baby whenever he asks, for as long as he wants, her body will know how much milk is needed. Day 2 / 3 Baby feeds furiously and appears very hungry. Baby is actually sending signals to mum s breasts to let them know it s time to make more milk. Mum can think baby is starving and that she hasn t made enough milk for her baby. In fact, there is no need to panic - as long as baby is fed when he wants and for as long as he wants, the right amount of milk will be made. Giving formula milk will interfere with this process and less breastmilk will be made. Day 5 Baby may lose a little weight - this is very normal for all babies, provided that the weight loss is less than 10% of baby s birth weight. If the weight loss is close to or greater than 10%, your midwife will discuss this with you and help you make a plan to increase the effectiveness of feeding. Either way it s important that baby continues to feed on demand (at least 8 times in 24hrs), so mum s breasts make plenty of milk and baby soons regains the weight. Around weeks 3, 5/6 & 12 Baby has a feeding frenzy, also known as a growth spurt, which may last a few days. This is normal and is the baby s way of telling mum s body that he is growing and developing and needs mum to make more milk. Mum may worry that she is not making enough milk and be tempted to give formula. However, giving formula will interfere with the supply and demand process and may reduce mum s breastmilk supply. If mum continues to follow baby s feeding cues, feeding as often and for as long at the breast as baby requires, she will make the right amount of breastmilk to meet baby s changing needs. realbabymilk.org 5
Breastfeeding Positions There are several ways to hold a baby to breastfeed, and we hope you find this guide to them useful - but it is important to note that all of them have things in common: P P P P P The position must be comfortable for you to stay in throughout the feed. The baby needs to be held close to your body, facing your breast. The baby s nose should be opposite your nipple at the start The baby s head, neck and body all need to be in a straight line (head and neck not twisted) The baby s head must be free to tilt backwards as he is brought into the breast. Cross Cradle Hold P Useful when you are just learning 1 Use your fingers under the baby s neck, so the weight of her head is supported, but make sure her head is free to tilt back between your thumb and finger. 2 The palm of your hand supports your baby s shoulders and you can press on her shoulders to bring her into the breast when ready. 3 Your forearm can tuck the rest of the baby s body close to you while she feeds. Underarm Hold Useful if you have: P A small or pre-term baby P A Caesarean section P Large breasts or inverted nipples 1 The baby is usually held on a pillow, just under breast height, turned slightly towards you. 2 It is very important that the baby is held very close to your side but is not able to touch anything (eg the back of your chair or your cushions) with her feet, otherwise she will push with her legs and will come too far forward. 3 Support your baby s neck and the weight of her head in the same way as in the cross cradle hold - so her head is free to tilt back. 4 When the baby feels your nipple against her nose, her head will be free to tip back between your finger and thumb as you press her shoulders in towards your breast. 6 realbabymilk.org
Lying Down Hold Useful if you have: P Painful stitches or haemorrhoids P A Caesarean section. P Also helpful if you are tired and need to feed and rest, but make sure it is safe for your baby if you were to fall asleep while feeding. 1 You need to lie on your side with your head on the pillows and your shoulders on the mattress. 2 Bend your legs slightly but not enough for the baby s legs to touch your thighs. 3 The baby should be on his side facing towards you with his nose opposite your nipple. Make sure none of your arm is pressing on the back or top of his head. His head must be free to tilt back. 4 You need to press on the baby s shoulders with your upper hand (or sometimes the fingertips of your lower hand) to bring him to the breast when he is ready. Cradle Hold The position most mums use instinctively Your hand needs to be supporting your baby s shoulders and make sure he is free to tilt his head back out over your wrist. The Laid Back Approach Another way to enable baby to access the breast is to place baby on your body and allow her to self attach. You need to be reclining so that baby feels secure. You may need to support baby and /or your breast. Positioning you and your baby in this way can help to gently encourage skin to skin and body contact, and to enjoy closeness without either feeling any pressure to get on with feeding. Instead, this position encourages your baby to use natural reflex behaviour to help him/her find the breast and feed effectively when ready. Enjoying time together in this way helps you and baby to have eye contact while feeding and for both of you to relax and make the most of these special times. NB: also known as Biological Nurturing, see www. biologicalnurturing. com for more information. realbabymilk.org 7
How will I know when my baby needs to be fed? Feeding Cues: P Hands to mouth P Turning head PLicking lips P Mouthing P Squeaking noises PLight fussing P Rooting (moving mouth and head as if looking for a feed) Safe Sleeping The safest place for your baby to sleep is in a cot or a crib in your room for the first 6 months. It is important never to fall asleep with your baby on a sofa or armchair. Bringing your baby into your bed means you can breastfeed in comfort. There are important points to consider before taking your baby into bed with you. Bed sharing is not appropriate if: Either parent is a smoker Either parent has been drinking or has taken drugs which make them very sleepy Pets or older children are also sharing the bed You are sleeping on an old or sagging mattress You or your partner are overweight Your baby is formula fed Parents must ensure baby cannot: Fall off bed Get entangled or overheated or become covered with pillows or duvet Ask you midwife or health visitor for the leaflet on caring for your baby at night or go to www.unicef.org.uk/babyfriendly/resources/ Resources-for-parents/Caring-for-your-baby-at-night/s How do I know if my baby is attached properly? P Your baby should have a large mouthful of breast P Your baby s chin should be indenting the breast P Your baby s cheeks should be full and rounded P If any areola is visible, there should be more above the top lip than below the bottom lip P Your baby s suckling pattern should change from rapid sucks to slow rhythmic suckling, and swallowing may be heard. P Your baby may pause from time to time, and will start suckling again without coming off or having to reattach. P Your baby should be relaxed and contented throughout the feed and should come off your breast on his own when he is finished. Your nipple should look the same shape as when the feed started P The feed should be pain-free and comfortable for you, although the first few sucks may feel quite strong. P Initial attachment may hurt for 10-20 seconds if your nipple is already damaged but the rest of the feed should be pain-free. 8 realbabymilk.org
Good Attachment Good attachment really is the key to successful breastfeeding. Use this guide to get it right from the start, but if you find you are still struggling - ask for help! Before you start - Make sure baby s head, neck and body are in a straight line - a baby cannot suckle or swallow easily if the neck is twisted. Good attachment is difficult for a baby to maintain if his body is twisted at the waist. The baby should be held so that the back of his shoulders is supported, and his head is free to tilt back. Please see Page 6/7 for tips on positioning baby so that he can attach effectively to the breast. If you are at all unsure about the attachment of your baby, seek help from your midwife, health visitor or maternity support assistant. You can also visit your local support group. Someone observing how your baby feeds can really help to get it right. 1. The baby should face the breast with nose to nipple - this allows the baby to tilt his head back so that the nipple is aimed at the roof of the mouth 2. When baby gapes wide open,press on the back of his shoulders to bring him in quickly - and you will need to move quickly! 3. Chin and tongue leading, head tilted back, the nipple goes into the back of roof of mouth as baby is brought towards the breast. 4. Attachment shouldn t be painful, baby should keep suckling and should let go on his own at the end of the feed. The nipple should look the same shape as before the feed. To see more examples of good attachment, see the Breastfeeding, by Mums, for Mums DVD ( 7.50) - it is available from www.realbabymilk.org/shop realbabymilk.org 9
Hand Expressing Why express by hand? P It can be used to help the baby attach to the breast P It can help to prevent or relieve engorgement P It is particularly useful for milk in very small quantities, e.g colostrum P It can be used to help clear blocked ducts P It can be more effective than a pump P It s free - no equipment needed! Storing expressed breastmilk Breast milk should be expressed into a sterile container if the baby is under 6 months old. For healthy term babies it can be stored at : P Room temperature for up to 6 hours P At the back of the fridge (not the door) for 5 days at 4 or lower P In the freezer at -18 for up to 6 months P For preterm or vulnerable babies, check with your local Neonatal Unit for guidance as storage is likely to be more cautious. 1. Roll your nipple between your finger and thumb to make it stand out. Make a C-shape with your thumb and either your index or middle finger, and cup your breast. Feel back from the end of the nipple to where the breast tissue feels different, about 2-3cm from the nipple, as shown in Fig.1. You may feel a change in the breast tissue at this point, sometimes it feels knobbly, sometimes slightly firmer. You are now touching the skin above the dense, milk-making tissue 2. Holding your finger and thumb in this C-shape, press back towards your rib cage, as in Fig.2. This brings your finger and thumb back into the dense, milk-making tissue, away from the ducts near the nipple. 3. Bring your finger and thumb together, so that they press into the milk-making tissue, and milk will begin to appear in droplets, as shown in Fig.3. Use a sterile cup or bowl to collect it, and try to build up a rhythm. Try not to slide your fingers over the skin, as this will hurt and it will be more difficult to express milk. When the flow slows down, move your finger and thumb around the breast or express from the other side, and you can keep changing breasts until the milk slows or stops. Practice makes perfect! If you are doing this when your milk supply is not yet established, you may need to repeat these 3 actions a few times to get the colostrum to flow and you may get 1-10mls (up to 2teaspoons full). You can keep moving your finger and thumb around or use the other hand to take milk from all around the breast, but the technique should remain the same each time. If your milk supply is established, the milk may spray out in several different directions. If you are not able to breastfeed your baby directly, you need to start expressing as soon as possible after the birth, preferably within 6 hours. Keep doing it at least 8 times in every 24 hours, including at least once at night, until baby is feeding properly. 10 realbabymilk.org Pst... Expressing Breastmilk by Hand DVD ( 11.50) available at www.realbabymilk.org/shop
Physical Challenges There are very few challenges which should cause you to finish feeding. With the right help and information, most challenges are temporary hitches. This page has some tips and our website has even more - www.realbabymilk.org Not enough milk? - First, check your positioning and attachment with a professional or at a support group. A poorly-attached baby can sometimes limit the milk flow. - How often are you feeding your baby? Demand feeding is the very best way to ensure that your body knows how much milk to make, but your baby should be feeding at least 8 times in every 24 hrs. Blocked Ducts / Mastitis Symptoms of mastitis are usually redness and tenderness of the breast, flu-like feelings (fever, shivers). Again these are often caused by poor attachment which doesn t allow the milk to flow freely and can cause blockages. If this occurs try to - Feed baby as often as possible, if too sore then express. It is important to keep the milk flowing. - Ibuprofen can help reduce swelling. - Paracetamol can reduce high temp. - Hot shower/bath/flannels to help milk flow - Cabbage leaves to relieve pain and throbbing. If all the above are not working within 24 hours, then antibiotics may be needed, maybe sooner if the nipple is damaged. Try to look after yourself as much as possible during recovery; relax, rest and eat well. Anxious about milk supply? - Are baby s wet and dirty nappies as expected for his age? See page 12. - Can you hear baby gulping and swallowing? - Do you feel full before a feed, softer afterwards? - Is baby settling between feeds? - Is baby gaining weight? It is common to feel anxious because you can t actually see how much milk is being made. If your answer to all five is yes, then rest assured your baby is getting enough milk. If not, seek support. Too much milk? - Milk supply usually tailors itself to baby s needs within 6-8 weeks - Try leaning back once baby is attached so milk comes out slower - Try feeding from same side at two consecutive feeds. Fullness on other side will help your milk supply to decrease - watch out for mastitis though. - Expressing extra milk for the freezer may help but be careful not to overdo it as you can end up making even more milk. Cracked / Sore Nipples? Cracked and sore nipples are nearly always caused by poor attachment. Try to get to a support group or ask your midwife to look at how your baby attaches and feeds. If nipples are scabbed apply breastmilk and promote moist healing. If nipples are bleeding / too painful to feed, try expressing for 12-24 hours to rest them and try again with the right help to get the positioning and attachment right. NB: Blood might sometimes pass into the milk, this is not at all harmful to your baby and is not a reason to stop. Full Breasts - Difficult to attach - Try expressing some milk before attaching baby, to relieve the pressure. - Try different positions - Keep feeding on demand so breasts do not become so full between feeds - Is your baby sleeping too long between feeds? Try waking baby to feed at shorter intervals. realbabymilk.org 11
Baby s Nappies - what s normal? It can be a little surprising to see what changes your baby s nappies go through. A breastfed baby will poo a variety of colours over a relatively short space of time. This page will help you to understand what is going on - and show you that what you see are signs of a well fed baby. Day 1-2 Day 3-4 Day 5-6 Older Breastfed baby Top tip: It is sometimes difficult to tell how wet a disposable nappy is due to it feeling dry. A wet disposable nappy generally feels heavier than when it is new and if you are really unsure try pouring three tablespoons of water into a new nappy to see what difference it makes. Day 1-2: The meconium nappies. Your baby s first poos will be black/dark green or brown/black and very sticky. Babies are born with meconium already in their bowel and it is very normal. Baby will also be having 2 or more wees a day. Days 3-4: Wetter nappies and greener poos Nappies at this stage are known as changing stools, the poo will be turning a more green colour and this is a sign that your baby is taking in more milk and digesting it. A baby of this age should have at least 2 poos a day. Baby will also be having three or more wees a day and wet nappies will feel heavier. Days 5-6: Yellow poos Your baby has cleared all the meconium (see day 1-2) from his/ her bowels and all babies of this age should be having at least 2 yellow, soft/runny poos, each of a size to cover a 2 coin, per day. This is a minimum - many babies will poo far more than this! This is nothing to worry about and is a good sign that the baby is getting plenty of breastmilk. Your baby should also be having at least 6 heavy wet nappies per day. Older Breastfed baby mustard poos As your baby gets older, the poos get yellower and are sometimes described as resembling mustard.. They should stay soft or runny, and may look seedy, this is fine and perfectly normal. Until the baby is at least 4 weeks old, you should continue to see at least 2 poos a day as described above. After this, some exclusively breastfed babies may go several days between poos. This is normal as long as the baby is feeding enthusiastically, having plenty of wet nappies and gaining weight. 12 realbabymilk.org
Special Circumstances Breastfeeding twins or other multiples Breastfeeding twins or other multiples (triplets or more) is challenging but also very important in keeping the babies healthy and providing opportunities to bond with each baby. It is extra important if the babies are premature, very small or need special care for any reason. As with any baby, it is important to get a breastmilk supply established, preferably by feeding the babies at the breast soon after birth and at least 8 times each in every 24 hours or expressing milk at least this often if any baby is unable to feed directly at the breast. It is very useful to have help in positioning the babies in the early days so as to be able to feed two simultaneously and save time on feeding. Breastfeeding while pregnant If you are breastfeeding when you become pregnant with another baby, it is absolutely fine to continue to breastfeed the older child throughout your pregnancy for all but a very few women. It may help you to keep your toddler calm and contented when you feel tired or unwell, and your toddler will continue to benefit from your milk and from the comfort and closeness he gets from breastfeeding. Many toddlers wean themselves off breastfeeding while mum is pregnant, because the milk supply does decrease, but some toddlers and some mums like to continue throughout the pregnancy, right up to the birth of the new baby. When breastfeeding of an older child continues following the birth of a new baby, it is important to ensure that the new baby is fed first and is fed according to their demands. It may be convenient to allocate a specific breast to each baby/child, according to preference or once the younger baby has established breastfeeding. Continuing to breastfeed the toddler and the new baby is called tandem feeding, and many mums find that continuing to breastfeed the toddler helps the older child to adjust to and accept the new baby. Breastfeeding older babies or children Breastfeeding of babies over the age of a year is not common in the UK. However, this is much more common in other countries and the World Health Organisation recommends continuing breastfeeding into the second year of life and beyond. Mothers who breastfeed older children may choose to do this for a variety of reasons. Continued breastfeeding may bring health benefits for babies. Breastmilk continues to contain antibodies from the mother s mature immune system and this may help protect older babies and children from common infections such as colds and stomach upsets. Breastmilk also continues to provide a valuable food source for older babies milk is an important part of the diet for young children and the milk of their own mother is specific to human children s needs. Read more on www.realbabymilk.org Breastfeeding a preterm or ill baby Breastfeeding is extra-important if your baby is born preterm or is ill. Such a baby is particularly vulnerable to infections and needs the milk which is specifically designed for a human baby, whatever stage of development they are at. If your baby is not able to breastfeed directly, you need to express your milk at least 8 times in every 24 hr period including once at night, until your baby is mature enough or well enough to be taking effective breastfeeds. You may need to give supplements or medicines as well as breastmilk, but in all but a few very unusual illnesses, your milk is the best thing for your baby to help him grow or recover. realbabymilk.org 13
Introducing other foods Introducing solid foods. At around 6 months babies are ready to move onto solids. Starting solid food is all about experimentation and is an enjoyable stage for you and your baby. Prior to this age, a baby s digestive system and kidneys are still developing and weaning too soon may increase the risk of infections or allergies. Delaying the introduction of solid foods beyond six months of age increases the risk of nutrient and energy deficiencies and is therefore not advised. Recognising when your baby is ready to try some food The signs to look out for, at about six months are that your baby: wants to chew & is practising this with toys and other objects can sit up can reach out and grab things. Whether you start with purees, soft finger foods or a combination of the two, the key to meeting your baby s nutritional needs, is to offer a range of foods from the following four food groups over the day: Potatoes and cereal based foods including bread, rice and couscous, pasta, porridge and other breakfast cereals Fruits and vegetables Milk products such as yoghurt, cheese, custard and milk puddings Meat, fish, hard boiled eggs, pulses Having started weaning, your baby will then need to progress through the various stages to develop the skills needed to eat a mixed nutritious diet. The table below gives an indication of the age when your baby will be able to learn the skills to manage different textures and enjoy mealtimes. Starting solid foods is all about experimentation and is an enjoyable stage for you and your baby. Just keep offering opportunities to try new foods and let your baby s appetite guide you both. As your baby eats more, the need for milk will become less and their appetite for solid food will increase. Age guide Skills to learn Textures to introduce Around 6 months Taking food from a spoon Moving food from the front to the back for swallowing Managing thicker purees and mashed foods Smooth purees Mashed foods Getting weaning started at around six months: First foods can be introduced at any time during of the day that is convenient for you and your baby. Choose a time of day when your baby is wide-awake and not too hungry. Foods to offer: You can begin with smooth puree or mashed foods such as banana or avocado, cooked mashed apple or pear. You could try cooked mashed parsnip, carrot or sweet potato offer these on a shallow teaspoon or weaning spoon You may decide to begin with soft finger foods such as steamed broccoli florets, carrot sticks, or pieces of apple or melon. 6-9 months 10-12 months Moving lumps around the mouth Chewing lumps Self-feeding using hands and fingers Sipping from a cup Chewing minced and chopped food Self-feeding attempts with a spoon Mashed food with soft lumps Soft finger foods Liquids in a lidded beaker or cup Hard finger foods Minced and chopped family foods It is important to continue to offer breastfeeds as they still provide a valuable source of nutrition for your baby throughout the first year and beyond. As your baby eats more, the need for milk will become less and their appetite for solid food will increase. For more information please go to the NHS Bristol Maternal and Child Nutrition Guidelines at http://www.bristol.nhs.uk/your-health/healthyeating/healthy-eating-for-under-5s.aspx 14 realbabymilk.org
Returning to work With a little forward planning, it is perfectly possible to continue to combine breastfeeding and working. If a mother intends to return to work very soon after the baby is born (for example if they are self employed), then it is essential that she ensures that breastfeeding is established and that she feels confident with feeding before starting back at work. Any mother who returns to work when her baby is less than six months old and exclusively breastfed will need to consider where and when to express her milk in order to maintain supply and meet her baby s needs. Many different settings are suitable for expressing, especially if hand expressing or non electric pump are used. Anywhere that is private, clean, warm and comfortable may be used, whether this is an unused office space, storage area, rest room (not the toilet!) or even a car with blinds on the windows if out and about. For a very young baby, mum will need to express as often as possible when separated from the baby, much as the baby would naturally feed. It is important to remember that it is the frequency and effectiveness of expressing which matters rather than the volume of milk gained, since it is this which will stimulate and maintain the supply. If mums return to work when their baby is over six months old and taking foods other than breastmilk, it is still well worth expressing milk at work to be fed to the baby by cup or bottle. If mum expresses two or three times during a typical eight hour working day, then this will probably provide sufficient breastmilk for the baby s needs alongside solid foods. Mum can then feed their baby at the breast as normal during days off and enjoy the convenience of this. Storage of expressed milk can be very straightforward. It may be most convenient to take a cool bag to work, complete with ice packs to keep the temperature inside quite low (below five degrees, like a fridge). Breast milk, unlike doorstep or formula milk, is very stable and does not go off very quickly. Please see page 10 for storage information. If a mother does not wish to express milk at work, it is still possible to continue to breastfeed. Baby may be given formula milk (if under one year) when mum is not available and then feed at the breast when mum returns. The breastmilk supply will respond to the demands made and breastfeeding can continue combined with bottle feeding, giving at least some of the health benefits of breastfeeding. Mums who choose this course of action may need to express a little in the first days back at work in order to keep their breasts soft and comfortable and reduce the risk of mastitis. Ask your health visitor for a leaflet on returning to work or study or go to www.unicef.org.uk/babyfriendly/ Resources/Resources-for-parents/ Breastfeeding-and-work/ realbabymilk.org 15
Accessing support & Breastfeeding friendly places in Bristol All the support groups are friendly and welcoming and many are run in conjunction with local health professionals, family services and local mums. Peer support is often available from mums who have successfully breastfed and who have had training to provide mother to mother support for breastfeeding. We have also listed a number of places that have signed up to be Breastfeeding Friendly to try and help when you are out and about. These establishments have committed to being welcoming to breastfeeding mothers and so you should be able to feed in peace and comfort! Visit our website: www.realbabymilk.org/bristol Milk Banking 17 Breastfeeding Helpline Info 17 Bristol Breastfeeding Counsellors 18 Breastfeeding Peer Support Service 18 Support groups in Bristol 19 Support groups in Gloucestershire 20 Breastfeeding Places Bristol 21 Breastfeeding Place Bristol 22 National Breastfeeding Support 23 If you need help with breastfeeding:- St Michael s Hospital 0117 3425214 24 hours Southmead Hospital 0117 9595305 24 hours Breastfeeding Counselling Helpline 0300 100 0212 La Leche League (UK) 0845 120 2918 National Childbirth Trust (NCT) 300 330 0771 Assoc. of Breastfeeding Mothers 08444 122 949 Young Mums and Breastfeeding Claim your own Bristol Young Mums information packspecially designed for you Find out tips and info from other young Bristol mums in your magazine Record your baby s first few months on a specially designed calendar Order your free bra Claim your well earned free treats as you go through the early weeks and months of breastfeeding Meet your local peer supporter who can help you through the first few days and weeks of breastfeeding Are you a teenage mum from Bristol? Get a free magazine with loads of tips on breastfeeding, as well as a calendar that charts your baby s growth and provides details on how you can get rewards for breastfeeding your baby. Ask your Midwife, Peer Supporter or Health Visitor for details. The pack is available for all young mums who were under the age of 18 when they became pregnant, and live in the Bristol area. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 16 realbabymilk.org
Milk Bank for Bristol Premature or sick babies benefit even more from receiving breast milk from their mums. Where this is not possible, donor breast milk from breastfeeding mums with extra to spare, can help to give them the best start in life. If you would like to know more about donating breast milk please contact the infant feeding advisors at Southmead Hospital Marion. Copeland@nbt.nhs.uk or Cathy.Churchill@nbt.nhs.uk The Precious Drops Campaign The Precious Drops Campaign has so far raised 75,000 for the milk bank that was opened in Southmead Hospital in November 2011. We are still raising money to support the milk bank. To hire a breast pump please contact a breastfeeding counsellor If you would like to know more information about this charity please go to www.preciousdrops.com Breastfeeding Helpline Info You do not have to be a member of these organisations to receive advice. National Breastfeeding Helpline 9.30am-9.30pm Tel: 0844 209 0920 Association of Breastfeeding Mothers [ABM] National Helpline: 08444 122 949 9.30am - 10.30pm La Leche League [LLL] National Helpline: 0845 120 2918 24 hours National Childbirth Trust [NCT] National Helpline: 0300 3300 771 8am - 10pm realbabymilk.org 17
Breastfeeding Support in Bristol All midwifery and health visiting team members have been trained in breastfeeding to meet the UNICEF UK Baby Friendly Initiative best practice standards. Bristol is the first Baby Friendly city in the country. http://www.bristol.nhs.uk/your-health/ breastfeeding/breastfeeding-in-bristol.aspx Midwifery support St Michael s Hospital 0117 3425214 24 hours Southmead Hospital 0117 9595305 24 hours Breastfeeding Specialist midwives St Michael s Hospital 0117 3425164 Southmead Hospital 0117 3233527 Health visiting support: Your health visitor will give you a contact number when she first visits you and someone is usually available during office hours. Medical support: If you have any medical concerns, please contact your local GP who will be able to help. Health Links Support and information for mothers who do not speak English - 0117 902 7115 or 07900 264435 Bristol and South Gloucestershire Breastfeeding Counsellors: Association of Breastfeeding Mothers Sandra 0117 902 3025 - BS13 Georgie 0117 377 8163 - BS4 Heidi 01275 393 266 - BS41 La Leche League [LLL] Charlie 0117 939 3028 - BS3 Vicky 0117 966 6229 - BS4 April 0117 924 0634 - BS6 Floredia 0117 924 0661 - BS7 To hire a breast pump please contact a breastfeeding counsellor Bristol Breastfeeding Peer Support Service What is peer support? It is local mother-to-mother support. Mothers who have breastfed and had some training are offering extra antenatal and postnatal information and support for mothers who live locally. Who can use the service? All mums who live in; Whitchurch Park, Hartcliffe, Bishopsworth, Filwood, Stockwood,Hengrove, Henbury, Southmead, Lockleaze, Kingsweston, Hillfields and Avonmouth. Where will I meet a peer supporter? Your peer supporter will offer you a home visit during your pregnancy and contact after. They can offer encouragement on the phone, via text or e-mail and can offer you some extra visits if this helps. There are also voluntary peer supporters in many of the breastfeeding support groups who also help to support breastfeeding mothers across Bristol. Where can I find out more? If you would like to know more about peer support or would like to train as a volunteer peer supporter, please contact Barnardos 0117 9782441. National Childbirth Trust (NCT) Jennie 0117 924 9291 - BS7 Toni 01934 642033 - BS22 Jo 01225 874 864 - BS30 Ann 0117 9109125 BS 16 Fiona 01454 856025 - BS35 Andrea 01275 851 463 - BS48 Val 01934 832800 - BS49 Marisa 01453 521 009 - GL12 Catherine 01225 317 997 - BA1 Heather 01225 424471 - BA2 18 realbabymilk.org
Support groups in Bristol Breastfeeding mothers are welcome at the groups below. If you are attending a group for the first time you may want to check that it s running that day by phoning the contact. Bristol Babes Breastfeeding Groups Group details can occasionally change. Please go to http://www.bristol.nhs.uk/your-health/breastfeeding/ breastfeeding-in-bristol.aspx for up- to-date information on breastfeeding in Bristol. Bristol Babes @ Bedminster Down Zion Community Art Space, Bishopsworth Rd, BS13 7JW Contact: Jess Tel: 0117 9231212 Friday 1-3.00pm Refreshments can be purchased Breastfeeding Counsellor & Peer Supporters present Bristol Babes @ Hartcliffe Hartcliffe Children s Centre, Hareclive Road Contact: Sandra Tanner Tel: 0117 978 2441 Monday 1-2.30pm Breastfeeding Counsellor & Peer Supporters present Refreshments & creche Bristol Babes@ Fishponds Please call 0117 9782441 to get the latest info on this forthcoming group. Bristol Babes @ Lawrence Weston Longcross Children s Centre, The Longcross, Lawrence Weston Contact: Sam Hillier-Smith Tel: 07920283713 Tuesday 09.30-11.00am Refreshments Bristol Babes @ Shirehampton Beachley Walk Centre Contact: Health visitors Tel: 0117 9162200 Wednesdays 11.30-1.30pm Refreshments Peer supporters & Breastfeeding Counsellor present Toys/crafts for children, breastfeeding resources Bristol Babes@ Southmead Southmead Children s Centre, Doncaster Rd Contact: Sam Hillier-Smith Tel: 07920283713 Tuesdays 1pm-3pm Peer supporters present. Refreshments, breastfeeding resources Bristol Babes @ Stockwood Burnbush Children s Centre, Whittock Rd Contact: Vicky Tel: 0117 3533503 Peer supporters and Breastfeeding Counsellor present Bristol Babes @ Withywood Four Acres Children s Centre, Four Acres Road Contact: Sandra Tanner Tel: 0117 978 2441 Tuesdays 1pm - 2.30pm Breastfeeding Counsellor& Peer Supporters present Refreshments. Creche other groups across the city Avonmouth Baby Club Avonmouth Children s Centre, Portview Rd, Contact: Children s Centre Tel: 0117 3533520 Friday 11.30.-1.30.pm Refreshments, toys & grass area. Peer supporters & sometimes a Breastfeeding Counsellor present Barton Hill Breastfeeding Support Group Wellspring Healthy Living Centre, Beam Street Contact: Community Midwife Tel: 0117 3041420 Thursday 11.30am-12.30pm Midwifery support worker present. Refreshments Bedminster Cherubs Windmill Hill City Farm, Philip Street Contact: Heidi Evans Tel: 01275 393266 Monday 11am-12.30pm Breastfeeding Counsellor & Peer Supporters present. Refreshments. Closed bank holidays & two weeks at Christmas & Easter Brentry & Henbury Breastfeeding drop-in Brentry and Henbury Children s Centre, Brentry Lane Contact: Sue Pereira/Rosie McCallumon Tel: 0117 9500844 Wednesday 11.30am-1pm Peer Supporters & Children s Centre workers present. Refreshments available Clifton Breastfeeding Support Group Hampton House Health Centre, Cotham Hill Contact: Becca Morgan Tel: 0117 330 2609 Monday 11am-1pm Midwife present. Refreshments available Knowle Bumps and Babes Ilminster Avenue Children s Centre, Knowle Contact: Rachel Morley Tel: 0117 903 9781 Fridays 1-2.30. All year round Peer Supporters, Midwifery Support worker, Children s Centre staff. Refreshments & creche La Leche League www.bristollllblogspot.com for details of when & where the group is meeting Contact: Charlie 0117 9393028 or Vicky 0117 9666229 Peer supporters present Lockleaze The Honeysuckle café The Blake Centre, Off Brangwyn Grove, Lockleaze Contact Jennie Cope Tel: 0117 3772840 Thursdays 11.30.-1.00 Refreshments. Peer supporters, Children s Centre staff St Anne s BAMBI St Anne s Children s Centre, St Anne s Park, Lichfield Road Contact: Midwife Tel: 0117 3773189 Monday 1:30.-3:00 Midwife, Peer Supporters & Children s Centre staff present. Refreshments St George & Air Balloon Breastfeeding Support Group, Air Balloon Surgery Contact: Sue Woodham [Midwife] Tel: 0117 908 6634 Tuesdays 11.30am to 12.30pm Midwife & Community Nursery Nurse present No refreshments. Peer supporter and Breastfeeding Counsellor present Whitchurch Bambinos Clinic Room, Whitchurch Health Centre, Armada Road Contact: Jennie Peacock Tel: 01275 547031 Tuesdays noon-1.15pm Breastfeeding Counsellor/Health visitor & Peer Supporters present. Refreshments. Siblings welcome-no creche Upper Horfield Breastfeeding Support Group Upper Horfield Children s Centre Contact: Pam Slater Tel: 01117 9031281 Tuesdays 3pm-4pm Children s Centre manager present. Refreshments realbabymilk.org 19
Support groups in South Gloucestershire South gloucestershire Bradley Stoke BOBS Bradley Stoke Children s Centre Bowsland Green Primary School Ellicks Close Bradley Stoke BS32 OES Tel: 01454 864150 Thurs 10.00-11.30.am Cadbury Heath breastfeeding group Sure Start Children s Centre Parkwall Primary School Earlstone Crescent BS30 8AA Tel: 0117 980 5731 Mondays 11am-12.30pm Downend Feeding Friends Downend Clinic Buckingham Gardens Downend BS16 5TW Tel: 0117 330 2505 Mondays 10.30am-11.30am Hanham BIB group Sure Start Children s Centre Hanham Youth Centre High Street, BS153EJ Tel: 01454 863500 Tuesdays 1.00-2.30 Kingswood Breastfeeding Café Kingswood Surestart Centre The Park Community Centre Hollow road Kingswood South Gloucestershire BS15 9TP 01454 864144 Thursdays 12.30 pm 2.00 pm Patchway Breastfeeding Group Patchway Sure Start Centre Coniston primary School Epney Close, Patchway South Gloucs, BS34 5LN 01454 864146 Tuesdays 10.00.-11.30.a.m. Thornbury breastfeeding group Sure Start Children s Centre Gillingstool Primary School BS352EG Tel: 01454 415750 [Midwives] Tel: 01454 415750 [Children s Centre] Thursdays: 1.30-3pm Yate Breast Friends Sure Start Children s Centre Cranleigh Court Road BS37 5DW Tel: 01454 855732 Tuesdays noon-1pm Support groups in North Somerset North somerset Banwell Baby Days Banwell & Winscombe Children s Centre Banwell Wednesdays 10 am - 10.30 am Tel: 01934 426774 Health visitor present Clevedon Bibs 4 Babes Clevedon Medical Centre Old Street BS21 6DG Contact: Health visitors Tel: 01275 876097 Thursdays 11.00 am-12.00 pm Health visitor present Nailsea Café Mamma Nailsea & Backwell Children s Centre Tel:01934 426710 Wednesdays 2.00 pm - 3.30 pm Health visitor present Portishead Café Mamma Portishead Children s Centre Contact: Sian Clason Tel: 01275 399881 Tuesdays, 9.30 am - 12.00 pm Peer supporters present Worle Weston-super-Mare The Latchers Milton and Old Worle Children s Centre Contact: Worle Health Visiting Team Tel: 01934 426618 Thursdays 11.00 am -12.30 pm Health visitor present Yatton Babes n Bumps breastfeeding coffee morning Yatton Moor Children Centre Tel:01934 426633 Tuesdays 11.00 am -12.30 pm Breastfeeding counsellor present 20 realbabymilk.org
The Bristol Breastfeeding Welcome Scheme Breastfeeding mothers and their families are especially welcome to breastfeed their babies at the venues listed below. There are over 260 members including First Bus who support the scheme. For further information please go to http://www.bristol.nhs.uk/your-health/ breastfeeding/breastfeeding-welcome-scheme.aspx North Bristol Avonmouth Avonmouth Community Centre Bishopston/Horfield Gloucester Road Born Bubalu Café Delight Café Pronto Coffee #1 Horfield Leisure Centre Bristol La Barrique La Ruca Lashings Coffee House Planet Pizza Rimando s Softplay Coffee Lounge Spice Route Tinto Lounge Lockleaze Cookies Café Lockleaze Honeysuckle Café at the Blake Centre Lockleaze The Cameron Centre Lockleaze EAST BRISTOL Easton Easton Leisure Centre Kebele Centre Easton Thali Café Eastville Mothercare Tesco Asda Homeworld Fishponds Porto Lounge St Werburghs St Werburghs City Farm Cafe SOUTH BRISTOL Avonmeads Mothercare Brislington Bocabar Sainsburys Bedminster Bristol South Swimming Pool Windmill Hill City Farm Café Sazz Circles Cuban Ice Hennessy s Coffee Lounge Masala Savannah Café Bar & Restaurant The Lounge The Tobacco Factory Bishopsworth Swimming Pool Hartcliffe The@Symes Community Building Barnardos Fulford Family Centre The Gatehouse Centre Knowle Acappella Banco Lounge Jubilee Swimming Pool Knowle West Health Park Southville Oasis Café Riverside Garden Centre Café Southville Deli Spike Island Café Withywood The Withywood Centre WEST BRISTOL Clifton Boston Tea Party Bristol Zoo Cafe Du Jour Café Gusto Clifton Kitchen Coffee #1 Primrose Café The Friary Redland Lashings The Chandos Clinic Henbury Henbury Leisure Centre Munchbox Breastfeeding mothers are also welcome at: Health centres/ GP surgeries Child health clinics Children s Centres Leisure Centres Libraries Swimming Pools realbabymilk.org 21
The Bristol Breastfeeding Welcome Scheme Breastfeeding mothers and their families are especially welcome to breastfeed their babies at the venues listed below. Breastfeeding mothers are also welcome at: Health centres/ GP surgeries Child health clinics Children s Centres Leisure Centres Libraries Swimming Pools Henleaze The Avenue The Bay Tree Café Kondi Lawrence Weston Home Farm Sansway House Day Nursery Westbury-on-Trym Café Mundo Stokes Croft Café Kino Hooper House Patisserie Leila The Arts House The Bristolian The Canteen The Runcible Spoon The Social Café Kino Café Kuvuka CENTRAL BRISTOL Broadmead Café Nero Debenhams Registry Office Cabot Circus Giraffe Cotham Blue Juice Deco Lounge Clifton (The Triangle) Browns Bristol Museum and Art Gallery Fresh and Wild Pizza Express Rocotillos Wagamama St Paul s St Paul s Community Centre St Pauls Learning and Family Centre The Waterfront Arnolfini @Bristol Blue Reef Aquarium Bordeaux Quay Firehouse Rotisserie The Ferry Station The Grain House - YHA Bristol Riverstation Restaurant Severnshed Restaurant Watershed Under the Stars 22 realbabymilk.org Kingsdown Kingsdown Leisure Centre Park Street Ask Boston Tea Party Bristol Guild Goldbrick House Nandos The Folk House Café Redland Lashings Coffee House The law is on your side! The Equality Act 2010 makes it clear that it s against the law for a women to get less favourable treatment because she is breastfeeding when receiving services.
National Breastfeeding Support & Information Breastfeeding Counselling Helpline 0300 100 0212 National Childbirth Trust (NCT) Helpline: 0300 330 0771 NCT have an excellent helpline with trained www.nct.org.uk breastfeeding counsellors available and excellent articles on their website Assoc. of Breastfeeding Mothers Helpline: 08444 122 949 www.abm.me.uk The ABM is a charity run by mothers for mothers who are committed to giving friendly support and accurate information to all women wishing to breastfeed. The ABM provides telephone and e-mail counselling as well as peer supporter and counsellor training. Local counsellors support mothers in breastfeeding groups in Hartcliffe, Withywood and Bedminster. The Breastfeeding Network (BfN) Helpline 9.30am - 9.30pm The Breastfeeding Network aims to be an Helpline: 0300 100 0210 independent source of support and information www.breastfeedingnetwork.org.uk for breastfeeding mothers La Leche League (UK) Helpline: 0845 120 2918 It offers a telephone helpline, on-line Help Forms, an www.laleche.org.uk on-line shop of breastfeeding, parenting and health professional publications and training courses Also worth a look... www.babyfriendly.org.uk www.breastfeeding.co.uk www.babymilkaction.org www.kellymom.com www.breastfeedingmanifesto.org.uk Disclaimer: Real Baby Milk CIC accepts no responsibility for the content of websites other than www.realbabymilk.org Real Baby Milk CIC, 17 Callywith Gate, Launceston Road, Bodmin, PL31 2RQ Telephone: 05601 536 629 Email: admin@realbabymilk.org www.realbabymilk.org Real Baby Milk is a not-for-profit organisation Company Number. 5963948. The Real Baby Milk logo and name is trademarked. This guide, it s information and images within are the copyright of Real Baby Milk 2009. All information is correct at time of going to press. Printed on a paper from a sustainable source. Photographers: Patrick Shanahan; Katy Blake Mums and Babies: Donna & Baby Pebble-Rose; Heidi & Baby Elizabeth; Bella & daughter; Portia & Ryder; Louise Big Stock Photo s, istockphoto. com and Visit Cornwall realbabymilk.org 23
Hints, tips and encouragement on public breastfeeding from mums Keep reminding yourself you are not doing anything wrong, and resist any urge to feel embarrassed. If anyone has a problem with it (and most people won t even notice what you are doing), remember it is their problem! I wore a pretty scarf to drape over me while feeding...that was until I got past caring! he he... then I just used to smile nicely if anyone looked at me and no one failed to smile back. Definitely practise. I sat in front of a mirror, then you can see what others can see. Being confident in what you are doing helps, just focus on your baby instead of worrying what people around you think! And always be armed with plenty of muslins! Being out with someone you know well and trust for first few times. Additional support and someone to giggle with if anything goes wrong. You can laugh about things with a friend that might seem overwhelming if you re alone or in unsympathetic company. I found wearing a vest top or a belly band under another top useful for covering my mum tum! A sling is good for holding lumps and hiding bumps! The first few times can be daunting but once you ve done it a few times it just seems like second nature and not such a big thing at all. Start off somewhere you feel comfortable or at a breast feeding support group and before you know it, a crowded place is no worries. If you re feeding in a cafe or similar and feel self conscious, try to find a seat in a quiet corner rather than facing out into the cafe and no one will see a thing. A cardigan to shield the side! Oh and quick reflexes for when little one gets distracted and lets go in a hurry!